Gender Equality and Health Indicators

in the Americas

Sixth Global Forum on Gender Statistics Helsinki, Finland, 24 to 26 October 2016

Anna Coates

Unit Chief Gender and Cultural Diversity Unit

Content 1. Mandates: Linked agendas

2. Objectives and premises

3. Process

4. Conceptual framework

5. Initially selected indicators

6. Next steps

1. Mandates

PAHO Gender Equality Policy: Evidence building; capacity strengthening

Strategy for Universal Access to Health and Universal Health Coverage

Global Strategy for Women’s, Children’s and Adolescent’s Health (2016-2030)

PAHO Regional Plan for the Strengthening Vital and Health Statistics

PAHO Resolution ´Addressing the causes of disparities in health service access and utilization for LGBT persons´

The SDGs: Goal 3 and beyond…

Multiple mandates

The SDGs: Integrated and indivisible

SDG-10

SDG-17

SDG-5

SDG-3

Ensure healthy lives and promote well-being for all at all ages

Gender equality and empower all women and girls

Reduce inequality within and among countries Strengthen means of implementation

Linkages: SDGs; Gender Equality Policy; Universal Health

GEP Resolution Universal health resolution

3.7, 5.6 ...universal access to sexual and reproductive

health-care services…

d) ...providing universal access to comprehensive, quality,

progressively expanded health services that are consistent with

health needs, system capacities, and the national context…

3.8 Achieve universal health coverage, including financial

risk protection…

h) advance toward eliminating direct payment ...a barrier to

access at the point of service, avoiding impoverishment and

exposure to catastrophic expenditures

5.4 Recognize and value unpaid care and domestic work…

c) include, as appropriate, in the National

Health Accounts indicators for the

unremunerated time devoted by men

and women to health care in the home…

10.2 ...empower and promote the social, economic and

political inclusion of all, irrespective of age, sex, disability,

race, ethnicity, origin, religion or economic or other status

j) ...empowerment of people and communities ... in order for

them to take an active role in policy-making, in actions to

identify and address health inequities…

10.3 Ensure equal opportunity and reduce inequalities of

outcome, including by eliminating discriminatory laws,

policies and practices and promoting appropriate

legislation, policies and action in this regard

d) incorporate a gender equality

perspective, as appropriate, in the

development, monitoring,

17.18 ...increase significantly the availability of high-

quality, timely and reliable data disaggregated by income,

gender, age, race, ethnicity, migratory status, disability,

geographic location and other characteristics relevant in

national contexts

b) generate and analyze data

disaggregated by sex and other relevant

variables;

PAHOSDG/Target

2. Objectives and premises

Operationalize synergies between SDGs and gender and health mandates in proposed indicators

Simplify indicator development and monitoring process for countries Promote accountability for advances on gender equality in health Identify a set of indicators that will measure the structural causes of

inequities in heath to inform transformative responses

Accelerate strengthening of health information systems to

monitor advances in gender equality in health • Institutionalize collection and analysis of data on structural causes of

inequalities • Promote intersectorial approaches to health information (Gender Equality

Observatory: proposal of one key indicator) • Make visible diversity and intersectionality visible (needs of diverse

populations)

Objectives

Premises

A cohesive ´set´ of indicators that together refer to key aspects of gender equality and health Common understanding of an indicator and its relationship to others

Clarity in what, how and why to measure Monitoring health disparities in access to health services linked to gender

inequalities Measuring the response from the health systems (and others) to disparities

and inequities in health Measuring the advances toward gender equality in health Disaggregated data (sex, ethnic identity, sexual orientation, geographical

location/subnational level)

Utility Regional / policy making relevance Technically viable

3. Process

Process

Conceptual framework on

gender equality and health updated

Basic and core indicators for monitoring advances on

gender equality in health selected

Generation of indicators,

analysis, and use of information

Validation and technical

refinement of indicators at

regional, subregional and national levels

Where we are now

Selection of key indicator to present to NWMs

4. Conceptual framework

Review of diverse conceptual frameworks

Health Status : - Demographics and Life Expectancy - Physical and Mental Health & Morbidity - Risk Factors or Life Styles - Gender-based Violence - Mortality

Social determinants of health: - Educational Achievement, Income and Income

Distribution - Paid and Unpaid Work - Social Conditions for Sexual and Reproductive Health

Proposed domains

Health systems performance: - Access to Health Services - Universal Coverage

Governance and sustainable development: - Education Systems - Environmental Degradation - Infrastructure - Legal Frameworks - Political Equality

Proposed domains (cont)

5. Initially proposed indicators

Initially proposed indicators (to be validated)

Domain 1: Health Status Basic Indicators Core

1 Adolescent fertility rate (ages 10-19),

2 Incidence and/or prevalence (or deaths) of select NCDs (to be determined)

3 Incidence and/or prevalence (or deaths) of HIV

4 Women and men who have experienced physical or sexual violence by current or former partner during the last year

5 Healthy life expectancy at age 60

6 Maternal mortality rate (per 100,000 live births)

7 Refugee or migrant population (as relevant) by country or territory of origin

8 Self-reported health status

9 Self-reported mental health status

10 Incidence and/or prevalence of obesity, overweight

11 Suicide deaths

Initially proposed indicators (to be validated) (contd.)

Domain 2: Social Determinants of health Basic Indicators Core

1 Access to income earned

2 Average number of hours spent on paid and unpaid work combined

3 Highest level of education achieved by adults (over 19 years)

4 Unmet need for contraception (% of married women ages 15-49)(prevalence of use)

5 Women and girls aged under 15 to 19 years who are mothers, by age group

6 Comparison of average income/wages earned

7 Average number of hours spent on unpaid health care work, by sex and tasks

8 Decent employment (i.e,., not precarious, seasonal or informal) compare to total employed

Initially proposed indicators (to be validated) (contd.)

Domain 3: Health System Performance Basic Indicators Core

1 Women and men with no access to sexual and reproductive health services

2 Deferred required health treatment due to cost, by type of health service

3 Out-of-pocket health expenditure (% of private expenditure on health, % of cost of service.% catastrophic)

4 Proportion of health workforce (doctors, nurses, midwives, dental practitioners, pharmacists), by sex of employee and decision-making authority

5 Pregnant women receiving appropriate prenatal care (at least 4 antenatal visits in the first trimester)

6 Community mental health service use per 1,000 population (or treatment of severe illness)

7 Obstetric violence – inappropriate interventions, including verbal and mental abuse to women during perinatal care

8 Health expenditure on public health (% of total health expenditure)

Initially proposed indicators (to be validated)

Domain 4: Governance and Sustainable Development Basic Indicators Core

1 Curriculum for sexual education is integrated in school systems

2 School attendance-primary, secondary and tertiary schools

3 Basic drinking water, by urban/rural

4 Availability of safe, legal abortions (legal framework and location of services)

5 Proportion of seats held by women, minorities in national/local parliaments

6 Centre-based full- and part-time day child care for age 0-5 and % of children aged 0-5 for whom there is a regulated child care space

7 Proportion of households with poor air quality / using biofuels for cooking and heating

8 Secure rights to land, measured by (i) documented rights to land, and (ii) feeling safe from arbitrary dispossession of land

6. Next steps

Validation of basic and core indicators at regional, sub-regional and national levels

Technical development and alignment

Agreements for producing the selected indicators regularly

Continue strengthening capacities for analysis and use in policy making and monitoring

Thank you

coatesa@paho.org